Surgical clamp for circumcision

ABSTRACT

A surgical clamp for circumcision operations, adapted to be held and operated by one hand, which includes in a single unit a pair of clamping members having cooperating clamping surfaces operatively associated with means for locking the surfaces to provide a line of excision and for unlocking the surfaces after the operation. Each clamping member is provided with a beveled end portion, adjacent to the clamping surfaces, which coacts to form a beveled channel for guiding the prepuce and membrane toward the clamping surfaces and which also leads into an oval concavity provided in the clamping members to safely depress the glands away from the clamping surfaces during the operation, facilitating the gauging of the amount of prepuce and membrane to be excised along a clean, well-coated line.

United States Patent Gottlieb 1 Sept. 11, 1973 SURGICAL CLAMP FOR CIRCUMCISION V [76] inventor: Nathan Gottlieb, 516 E. 28th 51., Exammefchammg Pace Paterson 07514 Attorney-S. A. Giarratana [22] F1led. Feb. 9, 1971 [57] ABSTRACT [21] Appl' 113983 A surgical clamp for circumcision operations, adapted to be held and operated by one hand, which includes [52] U.S. Cl 128/346, 81/322, 81/371 in a sing e uni a pair of clamping members having co- [51] Int. Cl. A61b 17/08, A6lb 17/326 operating clamping surfaces operatively associated [58] Field of Search 24/250 R; 128/346; wi h me ns for locking the surfaces to provide a line of 81/318, 319, 321, 322, 367, 368, 369, 370, 371 excision and for unlocking the surfaces after the operation. Each clamping member is provided with a beveled [56] References Cited end portion, adjacent to the clamping surfaces, which UNITED STATES PATENTS coacts to form a beveled channel for guiding the pre- 2,573,421 10 1951 Feiring.... 81/318 and membrfme wward the 'l' and 2,800,823 7/1957 Tugend 81/370 WhIChHISO leads 1nto an oval concavity prov1ded 1n the 3,306,143 2 1967 Ortman... 81/368 clampmg members safely dePfess the glands away 1,433,668 10 1922 Stein 24 250 R x from the Clamping Surfaces during the Operation, facili- 2,114,903 4/1938 Hoppenstand... 128/346 ng e g ging of h am un of prepuce and mem- 2,747,576 5/1956 Bronstein 128/346 brane to be excised along a clean, well-coated line. 2,921,486 1/1960 Burke 1 24/250 R 3,561,077 2 1971 Grant 24 250 R 1 Claim, 5 Drawing Figures PMENTEBSEPI mm INVIENTOR NATHAN GQTTLI EB SURGICAL CLAMP FOR CIRCUMCISION BACKGROUND OF THE INVENTION .Many types of circumcision clamping devices have been used to perform or assist in the performance of a circumcision wherein the penile foreskin is surgically removed. In carrying out circumcision operations, it is the practice to provide a clamp which comprises, in those most commonly used, a device in which the prepuce is clamped between the lip of a bell-type device and the rim of a receiving or coacting port to separate the foreskin from the glans prior to excision and to prevent excessive bleeding after the operation. These devices, at best, have a number of disadvantages such as having to maintain the prepuce in a proper position on the bell-type device until the clamp can be tightened or the proper amount of prepuce will not be clamped and the operation will be unsatisfactorily concluded. In addition, such devices are complex in structure and operation and are not designed to assure optimum ease of use and quick hemostasis at the line of excision.

SUMMARY OF THE INVENTION The present invention comprises a surgical clamp which overcomes the difficulties of heretofore available clamps by providing an instrument which can be held and operated with one hand. The clamp is provided with a pairof clamping members wherein one serves as a base clamping member with the other clamping member pivotally connected thereto so that cooperating clamping surfaces integral therewith clamp the foreskin therebetween. In this manner, the prepuce and membrane can be excised with a scalpel which utilizes the closed clamping members as a guide for excising a predetermined amount of prepuce and membrane. In addition, the clamping members are pro vided with beveled edges forming a beveled channel which permits the channelling of the prepuce and membrane between the clamping surfaces and an integral oval concavity which prevents the glans from being clamped between the clamping surfaces. The unitary clamp can be locked and unlocked with one hand, contrasting with presently available instruments which comprise three or four separate parts requiring at least a number of separate operating functions for clamping the foreskin in a manner suitable for excision. Further, the clamp of the invention is provided with adjusting means cooperating with the clamping members to maintain the pressure to close the clamping members at a desirable level.

BRIEF DESCRIPTION OF THE DRAWINGS Reference is now made to the accompanying drawings for a better understanding of the nature and objects of the present invention. The drawings illustrate the best mode presently comtemplated for carrying out the objects of the invention and are not to be construed as restrictions or limitations on its scope. In the drawings:

FIG. 1 is a top sectional view of the invention in an open position;

FIG. 2 is a side view of the invention;

FIG. 3 is a top sectional view of the invention in a closed position, taken along line 3--3 of FIG. 2;

FIG. 4 is a bottom view of the invention of FIG. 1; and

FIG. 5 is an exploded view of the invention.

DESCRIPTION OF THE PREFERRED EMBODIMENT pivoted to the base clamping member 12 and that the locking arm 22 is also independently pivoted on the base clamping member so that the locking member is in a juxtaposed operative position with respect to the clamping member 16.

The base clamping member 12 is provided with an aperture 30 adjacent to its clamping surface 14 having spring means 32 mounted therein biasing the clamping member 16 in an open position. relative to the base clamping member. In addition, base clamping member is provided with an adjusting set screw 34 adjustably bearing against a suitably angled contact surface 36 on the adjusting cam 24. A locking set screw 38 is also provided on the base clamping member operatively adjustable against a locking surface 40 provided on the adjusting cam so that coordinated adjustment of the locking and adjusting set screws maintains the locking arm 22 in a predetermined relationshipwith the clamping member 16 and thereby determines the amount of pressure required to close the clamp. The base clamping member 12 is provided with a beveled end portion 42 which cooperates with a correspondingly beveled end portion 44 on the clamping member 16 to form a beveled channel 46 leading to the: clamping surfaces 14 and 18.

An oval concavity 48 is provided on the undersurface of the clamp 10 consisting of a semi-oval concavity on the base clamping member cooperating with a semioval concavity on the clamping member 16. It should be noted that the oval concavity 48 is located adjacent the clamping surfaces 14 and 118 and operatively coacts therewith during an operation as hereinafter disclosed.

The clamping member 16 is provided with integral predetermined elevated portions 50 and 52 at the respective ends of the clamping surface 18, so that the clamp in a closed position provides sufficient separation between the clamping surfaces, approximately 0.004 to 0.005 inches in the preferred embodiment of the present invention, to provide hemostasis at the line of excision without severing the foreskin.

In addition, the clamping member 16 is provided with a spring-biased alignment pin 54$ coacting with an alignment aperture 56 provided on the base clamping member 12 to assist in maintaining the clamping surfaces 14 and 18 in proper clamping alignment. Further, clamping member l6 is provided adjacent to its beveled end with a locking plate 58 mounted therein by suitable securing means, such as pins 60 and 62, and provided with an integral fulcrum 64, immediately above pin 62, operatively. coacting with a locking lever 66 pivotally mounted on the locking arm 22 by a pivot pin 68. The locking lever 66 is provided at its end opposite pivot 68 with a suitable bearing surface 70 adapted to operate within the fulcrum point 64 of the locking plate 58, so that the locking lever 66 and the locking arm 22 pivoted thereto will be fulcrumed at the point 64. The locking lever is positioned relative to the locking arm 22 and the fulcrum point 64 so that in its closed or locked position, the arm 22 will have fulcrumed the locking lever to a vertical position or to a position slightly beyond the vertical so that the locking arm is locked by the locking lever and, in turn, the clamping member 16 is locked against the base clamping member 12 and the two clamping surfaces are in an operative position with respect to each other. In addition, the locking lever 66 in its substantially vertical locked position with respect to the fulcrum point 64, has actuated the alignment pin 54 against the bias of the spring 32 into the alignment aperture 56, assuring that the clamp is in a locked and aligned position. It can be seen from the relative structural relationship between the adjusting cam 24, the locking arm 22, and the clamping member 16, that the relative adjustment of the set screws 34 and 38 will determine the relative position of the adjusting cam about its pivot 28 which, in turn, will determine the pressure required to actuate the locking arm 22 about its pivot 26 against the locking lever 66.

To release the locking arm 22 and thereby separate the clamping surfaces 14 and 18 after the operation, a releasing lever 72, provided with pivot apertures 74 operatively associated with the pin 62, is pivotally mounted on the locking plate 58 below the fulcrum point 64. The releasing lever '72 is provided with a pair of integral unlocking flanges 76 so that pivoting of the releasing lever about the pin 62 angularly actuates the unlocking flanges 76 to bias a lower portion 78 of the locking arm 22 to fulcrum the locking lever 66 from its vertical position to unlock the locking arm 22.

in the operation of the invention, the subject of the circumcision operation is prepared in that the prepuce is stretched by inserting dorsally a closed hemostat or a probe into the preputial orifice to the rim of the glans, so that opening the hemostat or probing will loosen the mucous membrane from the glans. After removing the hemostat, the prepuce can be retracted and the glans exposed, to insure that the rim of the glans is free of adhesions. Thereafter, the foreskin and mucosa are brought back to their normal position. Next, the foreskin is prepared for application of the clamp 10, in that the foreskin is held with thumb and forefinger of one hand and a lubricated tip of a hemostat is inserted into the dorsal aspect to a depth of three-fourths of the distance between the orifice and the corona. Then, both prepuce and membrane are grasped with a hemostat which is locked and transferred to the palm of the other, or free, hand. Then one tip of another hemostat is inserted into the frenulum aspect up to the sulcus, and both the foreskin and mucosa are grasped and the hemostat locked and placed in the palm of the other hand, which is also holding the first hemostat. With the thumb and forefinger of the hand holding the hemostats close to their tips, the clamp 10 is placed diagonally along the proposed line of excision outside the tips of the hemostats. The clamp is placed along the line of excision simply by placing the beveled end portions 42 and 44 over the foreskin and moving the clamp downward until the foreskin is between the two clamping surfaces 14 and 18. In the meanwhile, the beveled channel 46 insures that the glans is guided into the oval concavity 48 to assure that the glans is safely depressed away from the clamping surfaces. Next, the locking arm 22 is actuated to a closed or locking position by grasping the clamp between the thumb of the right hand adjacent the base clamping member 12 and the locking arm 22 with the right forefinger and applying pressure on the locking arm until the locking lever 66 is fulcrumed to its substantially vertical position to lock the locking arm 22 and the clamping member 16 in a closed position. At such time as the locking lever 66 is fulcrumed to its vertical or locking position, a click will indicate that the clamp is locked securely in position. Then the prepuce and membrane are excised with a scalpel as close as possible to the top surface of the clamp 10. Thereafter, the clamp 10 may be held in the left hand and with the right thumb bracing the clamp, the clamp is open by pressing the releasing lever 72 with the right index finger. After the clamp has been removed, with thumb and forefinger in 6 and 12 oclock positions, apply slight downward pressure to the coaptation of foreskin and membrane to expose the glans.

It will be apparent that with the apparatus of the invention the time taken to perform the operation is reduced considerably. The clamp can be applied and the circumcision canbe completed, including putting on the collar dressing after the operation, in a matter of from 8 to 12 seconds, unlike other presently available apparatus which require from 40 seconds to 20 minutes, or more. in addition, the clamp 10 is a single unit and can be locked and unlocked with one hand. This is in contrast to instruments made of three or four separate units, whose use entail quite a bit of fumbling, particularly in the hands of the occasional operator. Further, the removal of the clamp 10 after completion of the circumcision operation does not open up the maptation and thereby create a tendency to bleeding as do other presently available clamps.

Further, if the clamp 10 over the years requires an adjustment in the pressure required to lock the arm 22, the locking set screw 38 can be loosened and, in turn, the adjusting set screw 34 can be given approximately a one-fourth turn to advance the adjusting set screw toward the adjusting surface 36 of the adjusting cam 24; next, the locking set screw is relocked so that it is secured against the locking surface 40 of the adjusting cam 24. In practice, the clamp of the present invention was tested, in an open and close cycle, and required minor adjustment after approximately 4,000 test cycles.

Of course, other variations of the specific construction and arrangement of the surgical clamp for circumcision disclosed above can be made by those skilled in the art without departing from the invention as defined in the appended claims.

What is claimed is:

1. A surgical clamp for circumcision comprising a first clamping member including an elongated flat arm having an edge providing a first clamping surface and an adjacent broader surface providing an under surface, a second clamping member similar to said first clamping arm pivotally connected to said first clamping member at a first pivot point and having a second clamping surface and an adjacent under surface, an adjusting cam pivotally mounted on said first clamping member, at a second pivot point, a latching arm pivotally mounted on said adjusting cam in a juxtaposed operative position to said second clamping member, an aperture in said first clamping member adjacent said first clamping surface, a spring member mounted in said aperture and biasing said second clamping member in an open position relative to said first clamping member, an adjusting set screw threadedly mounted in said first clamping member and adjustably bearing against said adjusting cam, a latching set screw threadedly mounted in said first clamping member and adjustably bearing against said adjusting cam, whereby coordinated adjustment of said adjusting and latching set screws maintain said latching arm in a predetermined relationship with said second clamping member to thereby determine the amount of pressure required to close the clamp, each of said clamping members provided with a beveled end portion adjacent its respective clamping surface to receive the foreskin along a line of excision to guide it to said clamping surfaces and form on the under surface of the clamp a beveled channel to guide the glans to said clamping surfaces, a semi-oval concavity on the under surface of each of said clamping members forming an oval concavity adjacent said beveled channel to safely depress the glans away from said clamping surfaces during the operation to facilitate the gauging of the amount of foreskin to be placed between said clamping surfaces, said second clamping member provided with integral elevated portions at the respective ends of said second clamping surface providing a separation between said clamping surfaces in the closed position of the clamp to obtain hemostasis at the line of excision without severing the foreskin, a springbiased alignment pin mounted on said second clamping member coacting with an alignment aperture in said first clamping member to maintain said clamping surfaces in clamping alignment in the closed position of the clamp, a latching plate mounted on said second clamping member adjacent said beveled end portion and provided with an integral fulcrum, a latching lever having an endpivotally mounted on said latching arm and provided with a bearing surface at the other end mounted on said fulcrum so that a closing movement of said latching arm shifts said latching lever on said fulcrum slightly beyond a vertical position relative to said fulcrum to latch the clamp in a closed position, a releasing lever pivotally mounted on said latching plate below said fulcrum and provided with integral unlatching flanges whereby pivoting of said releasing lever angularly actuates said unlatching flanges to bias said latching arm and thereby shift said] latching lever from said vertical position to unlatch said latching arm. 

1. A surgical clamp for circumcision comprising a first clamping member including an elongated flat arm having an edge providing a first clamping surface and an adjacent broader surface providing an under surface, a second clamping member similar to said first clamping arm pivotally connected to said first clamping member at a first pivot point and having a second clamping surface and an adjacent under surface, an adjusting cam pivotally mounted on said first clamping member, at a second pivot point, a latching arm pivotally mounted on said adjusting cam in a juxtaposed operative position to said second clamping member, an aperture in said first clamping member adjacent said first clamping surface, a spring member mounted in said aperture and biasing said second clamping member in an open position relative to said first clamping member, an adjusting set screw threadedly mounted in said first clamping member and adjustably bearing against said adjusting cam, a latching set screw threadedly mounted in said first clamping member and adjustably bearing against said adjusting cam, whereby coordinated adjustment of said adjusting and latching set screws maintain said latching arm in a predetermined relationship with said second clamping member to thereby determine the amount of pressure required to close the clamp, each of said clamping members provided with a beveled end portion adjacent its respective clamping surface to receive the foreskin along a line of excision to guide it to said clamping surfaces and form on the under surface of the clamp a beveled channel to guide the glans to said clamping surfaces, a semi-oval concavity on the under surface of each of said clamping members forming an oval concavity adjAcent said beveled channel to safely depress the glans away from said clamping surfaces during the operation to facilitate the gauging of the amount of foreskin to be placed between said clamping surfaces, said second clamping member provided with integral elevated portions at the respective ends of said second clamping surface providing a separation between said clamping surfaces in the closed position of the clamp to obtain hemostasis at the line of excision without severing the foreskin, a spring-biased alignment pin mounted on said second clamping member coacting with an alignment aperture in said first clamping member to maintain said clamping surfaces in clamping alignment in the closed position of the clamp, a latching plate mounted on said second clamping member adjacent said beveled end portion and provided with an integral fulcrum, a latching lever having an end pivotally mounted on said latching arm and provided with a bearing surface at the other end mounted on said fulcrum so that a closing movement of said latching arm shifts said latching lever on said fulcrum slightly beyond a vertical position relative to said fulcrum to latch the clamp in a closed position, a releasing lever pivotally mounted on said latching plate below said fulcrum and provided with integral unlatching flanges whereby pivoting of said releasing lever angularly actuates said unlatching flanges to bias said latching arm and thereby shift said latching lever from said vertical position to unlatch said latching arm. 